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DARBY, Pa. — Authorities hope to learn today why a psychiatric patient allegedly killed a caseworker at a hospital complex outside Philadelphia and whether a psychiatrist who shot the patient with his own gun, wounding him, had feared the man.

The psychiatrist, Lee Silverman, was grazed in the temple during the gunfight in his office Thursday afternoon with patient Richard Plotts, Delaware County District Attorney Jack Whelan said.

“There were some issues between the doctor and the patient, but whether or not he actually feared him is unclear,” Mr. Whelan said.

Mr. Plotts, 49, of Upper Darby, remained hospitalized in critical condition. He was expected to be arraigned on murder charges today at his hospital bedside in Philadelphia, said Emily Harris, Mr. Whelan’s spokeswoman.

The slain caseworker, 53-year-old Theresa Hunt of Philadelphia, had accompanied Mr. Plotts to the psychiatric crisis center at Mercy Fitzgerald Hospital in Darby, just southwest of the city, authorities said.

“When the caseworker was shot, (Dr. Silverman) crouched down behind the desk to avoid him being shot,” Mr. Whelan said. “He was able to reach for his weapon, and realizing it was a life or death situation, was able to engage the defendant in the exchange of gunfire.”

The struggle spilled out into the hallway, where another doctor and caseworker jumped in to help Dr. Silverman and secure Mr. Plotts’ weapon, Mr. Whelan said.

Police in Upper Darby were aware of at least three mental health commitments involving Mr. Plotts — once after he cut his wrists and once when he threatened suicide — but said such stays can last just one to three days.

Mr. Plotts also had at least four gun arrests, along with assault and drug charges, according to police and court records. And he has been barred from at least one residential shelter because of his violent history, Upper Darby police Superintendent Michael Chitwood said today.

“The case workers and the doctors and the catchment centers — they know who violent individuals are, because they’re frequent fliers. And the system is not geared toward keeping these people housed somewhere until they start to be better. So you put whole communities at risk,” Chitwood said.

Mr. Plotts may have been angry with Dr. Silverman over his treatment plan, Mr. Whelan said. Colleagues heard arguing during the appointment and saw Mr. Plotts aiming a gun at Dr. Silverman when they peaked inside the door. They quietly backed out and called 911. The shooting soon began, just before 2:30 p.m.

However, Mr. Whelan did not know if Dr. Silverman was carrying a gun because of a specific fear of Mr. Plotts.

The psychiatrist was recuperating at home today. His wife said he did not want to discuss the shooting, and she also declined to comment.

Plotts does not have a listed home number, and it was unclear if he has relatives in the area.

Hospital policy bars anyone except on-duty law enforcement officers from carrying weapons on campus, a Mercy Health System spokeswoman said. She otherwise declined to discuss the reports that Dr. Silverman was armed at work.

“We remain focused on working with the Delaware County Police Departments to understand fully the details of the event,” said the spokeswoman, Bernice Ho.

Yeadon police Chief Donald Molineux said that “without a doubt, I believe the doctor saved lives.”

“Without that firearm, this guy (the patient) could have went out in the hallway and just walked down the offices until he ran out of ammunition,” the chief said.

Both guns were recovered from the scene. The exchange of gunfire occurred on the third floor of the Wellness Center at Mercy Fitzgerald, a 204-bed community teaching hospital. There are no surveillance cameras in the doctor’s office or the waiting area outside, and no metal detectors at the entrance, authorities said.

Cathy Nickel, a neighbor at Plotts’ last known address, an apartment complex in Upper Darby, saw a caseworker move him out of the building about a year ago. As he was taken away in a van, she said, he yelled, “You haven’t heard the end of me!”